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The 2014 contract: How the money is moving

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by Pulse Today on 10 December 2013

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Transcript of The 2014 contract: How the money is moving

The 2014 contract: How the money is moving
QOF
Framework completely overhauled and cut by almost 40% – 341 points retired, with the removal of the entire Quality and
Productivity domain


Three points from LD002
Transferred to extended learning disabilities DES
Learning disabilities DES
Annual health checks extended to patients aged 14-17 years. Added requirement to produce a health action plan
Dementia DES
• To be extended for a further year with 50% of funding available for engagement – other 50% to be paid for activity but details of this ‘not yet finalised’
• Changes to be introduced to offer advanced care planning to patients diagnosed with dementia and ‘allow greater professional judgement in which patients should be offered assessment to detect possible dementia’

10 extra points for HYP002
To recognise the high workload involved and the removal of HYP003, introduced this year, 10 points are added to HYP002 (BP 150/90 mmHg or less, now 20 points)

Other QOF changes
• The timeframe for the flu indicators (CHD004, COPD006, DM010 and STIA006) will move from
1 September to 1 August
• The timeframe for cancer reviews (CAN002) will extend from three months to six months
• The reference to 12 months will be removed from AF003, to be in line with the wording of AF004
• The timeframe for reviews of new patients with depression will be extended from 10-35 days to two to eight weeks (DEP002)
• STIA002 will be amended so that it only refers to the latest recorded stroke or first TIA
• LD001 (learning disability register) will now include all patients

Seniority payments removed from April 2014
• Current payments to be phased out over six years, ending in 2020
• No new entrants to the scheme from 1 April 2014
• Money released from seniority ‘pot’ goes into core funding

Last year's changes reversed
Planned hike in upper achievement thresholds ‘deferred for one year’ and most of last year’s imposed new indicators removed. NICE’s menu of proposed new indicators has been shelved
185 points from clinical domain
185 points from clinical domain
transferred to global sum. The indicators axed include:
• Imposed idicators HYP003, 004 and 005, plus DM014 and 015 and the unpopular depression screening indicator DEP001
• Renal function and eye checks in diabetes (DM005/001)
• Cholesterol checks (CHD003, PAD003, STIA004/005)
• Cardiovascular risk checks in severe mental illness (MH004/005/006)

33 points from patient
experience domain
Transferred to global sum

Alcohol abuse DES
Assessment for depression and
anxiety to be added


33 points from public health
Transferred to global sum
100 points from Quality and Productivity domain
Transferred to new enhanced service on
unplanned admissions


Global sum
All funding being transferred into
core funding will not be subject
to the 6% out-of-hours deduction.
All practices, including those with
correction factor, will receive
funding transferred
into the global sum


New unplanned admissions DES
Worth £160m in total. Practices must identify ‘at least’ 2% of adult patients – and any children – with complex needs and provide them with proactive care:
• Named, accountable GP to provide personalised care plans and co-ordinate care for each patient
• Same-day telephone consultations for all at-risk patients
• Dedicated practice telephone number for A&E, ambulance service and care home staff, to support decisions relating to admission and transfer to hospital

Enhanced services
Wide-ranging changes to enhanced services, with creation of new unplanned admissions DES and removal of three DESs
introduced last year
Extended hours DES
Continues for further year and is ‘adapted to promote greater innovation’. Practices will be allowed to work with others to deliver extended hours collaboratively across a wider area
Updating deprivation factors
Changes to the Carr-Hill formula have been deferred and will be implemented from April 2015
MPIG payments
Seven-year phase-out to begin from April 2014 as agreed last year. Measures to protect outlying practices are yet to be agreed
Patient online DES
Abolished, although some elements become core contractual requirements. £24 million funding transferred to global
Risk profiling DES
Remote care
monitoring DES
Patient participation DES
Continues, but with changes to allow practices
greater flexibility; local practice surveys will
be removed.
£20 million funding retained with the other
£40 million reinvested into core funding

PMS Contracts
To be agreed later in the financial year
but NHS England wants to ensure an
'equitable approach' in relation to PMS.
Changes such as the new unplanned
admissions enhanced service likely to be
'mirrored' for PMS practices but WOF
reform and changes to seniority 'require
further work to decided how such changes
might apply to PMS contracts'.
Devolved nations
Northern Ireland GPs will have 240 points removed from the QOF and shifted into the global sum, under and agreement due to be finalised soon. In Wales, talks centre on cutting bureaucracy and 'inappropriate' workload. The BMA hopes for agreement by Christmas. Scottish talks are
at 'an early stage'.
GPs' new contractual responsibilities
Abolished – £12 million funding
transferred to global sum
New 'named GP' role
Each patient aged over 75 years to have a named GP with round-the-clock accountability
Patients need to be informed who their named GP is by 30 June 2014, while newly registered patients must be notified within 21 days of registering
Responsibility to monitor out-of-hours care
GPs who have opted out of out-of-hours care will have a new contractual duty to:
Monitor o-o-h services, and raise any concerns with NHS England/their CCG
Co-operate with providers and agree timely sharing of patient data
Review clinical details of all o-o-h consultations the same day
Improving online services
Practices to promote and offer online appointments, repeat prescriptions and access to Summary Care Records as part of the core contract from April 2014
From 1 April practices must update the SCR on at least a daily basis, or have a published plan to do so by end of March 2015
Practices must use 'GP2GP' to transfer new patient records, or have a published plan to do so by end of March 2015
Practices contractually required to include NHS number as primary identifier in all clinical correspondence
GP pay to be published
Starts with next year's net NHS earnings, to be published from 2015/16 onwards
Details 'to be worked out' but practices to publihs average salary across each practice, not individual GPs' salaries
CQC ratings to be displayed
Once new inspection arrangements are agreed, practices will have to display Ofsted-style CQC ratings in waiting rooms and on practice websites.
Practice boundaries scrapped
Practices will be able to remove boundaries on a voluntary basis from October 2014, and to register patients from further afield without a duty to provide home visits. Local area teams will be responsible for urgent care at or near home for these patients.
Friends and family test
By December 2014, practices must ask patients the following question: 'How likely are you to recommend our practice to friends and family if they need similar treatment?' They must also ask one follow-up question of their choosing, provide monthly feedback to NHS England and publish the results
Key
Movement of money
Transfer of responsibility
Abolished DESs
Abolished, with funding transferred into the new unplanned admissions DES
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